Cardiogenic shock
What is the most common cause of cardiogenic shock?
1. heart failure
2. heart attack
3. hypertension
4. fluid loss
Heart attack
What is the main treatment for hypovolemic shock due to hemorrhage?
1. iv fluids
2. diuretics
3. blood product transfusion
4. monitor, no treatment
Blood transfusion including packed red blood cells, plasma and platelets.
What is the first treatment for anaphylaxis?
1. diuretic
2. beta- blocker
3. epinephrine
4. atropine
epinephrine
Choose two early signs of systemic inflammation.
1. bradycardia
2. bradypnea
3. tachypnea
4. fever
5. low WBC count
6. tachycardia
Fever (temperature higher than 38 C or hypothermia (temperature less than 36 C)
Tachycardia (heart rate more than 90 beats per minute)
Tachypnea (respiratory rate more than 20 breaths per minute)
Leukocytosis (WBC greater than 12,000/cu mm) / leukopenia (white blood cells (WBC) less than 4,000/cu mm) with or without bandemia (more than 10%)
What is the number one cause of neurogenic shock?
1. brain injury
2. blunt cervical spine injury
3. car accident
4. lumbar spine injury
blunt cervical spine injury
What are three other causes of cardiogenic shock?
1. heart failure
2. hypotension
3. stroke
4. pneumonia
5.chest injures
6. blood clot
Heart failure; chest injuries; medicine side effects; and conditions that prevent blood from flowing freely through your heart, such as a blood clot in the lungs.
What are the two causes of hypovolemic shock?
Hemorrhage (blood loss) and extracellular fluid loss
What should patients be encouraged to wear for safety?
medical alert braclet
Neurogenic shock is associated with which segment(s) of injury to the spine? SATA
1. lumbar
2. thoracic
3. sacral
4. cervical
cervical and high thoracic spine injury
What type of diagnostics may be ordered to evaluate a patient for cardiogenic shock? SATA
1. labs
2. chest xray
3. echocardiogram
4. cardiac CT scan
5. coronary angiography
6. ekg
Labs (such as abg, bmp, cbc), cardiac CT scan, chest x-ray, coronary angiography, echocardiogram, EKG
Choose three causes of hemorrhagic shock?
1. diuretics
2. bleed from ectopic pregnancy
3. diabetic ketoacidosis
4. liver failure
5. trauma
6. gi. bleed
7. infection
- Trauma (#1 cause)
-gastrointestinal (GI) bleed
-bleed from an ectopic pregnancy
-bleeding from surgical intervention
-vaginal bleeding
What diagnostic is used to to determine the cause of anaphylactic shock?
1. physical assessment
2. medical history
3. allergy list
4. allergy testing
allergy testing
Name three signs/symptoms that will be observed in septic shock.
Altered mental status
Oliguria or anuria
Hypoxia
Cyanosis
Ileus
hypotension
fever
tachycardia
tachypnea
hypothermia
Besides trauma, choose three causes of neurogenic shock.
1. spinal anesthesia
2. lung cancer
3. autonomic nervous system toxins
4. hemorrhagic stroke
5. Trisomy 21
-spinal anesthesia
-Guillain-Barre syndrome
-autonomic nervous system toxins
-transverse myelitis
-other neuropathies
-Trisomy 21
-skeletal dysplasia
-tonsillopharyngitis
What is the main treatment for hypovolemic shock related to fluid loss?
Fluid resuscitation with 2 liters of isotonic crystalloid solution infused rapidly. (Isotonic saline is hyperchloremic relative to blood plasma, and resuscitation with large amounts can lead to a hyperchloremic metabolic acidosis. Several other isotonic fluids with lower chloride concentrations exist, such as lactated Ringer's solution or PlasmaLyte. Fluid chosen will be upon patient chemistry and physician preference.)
Name the substance released by the body during anaphylaxis.
Histamine
Name four risk factors that put a patient at risk for septic shock.
Diabetes
Malignancy
Chronic kidney and liver disease
Use of corticosteroids
Immunosuppressed state
Burns
Major surgery
Trauma
Presence of indwelling catheters
Prolonged hospitalization
Hemodialysis
Extremes of age
What occurs in the body during cardiogenic shock?
1. blood clots develop
2. decreased oxygenation to the brain
3. decreased blood and oxygen to all vital organs
4. release of histamines due to allergic reaction
Your heart cannot pump enough blood and oxygen to the brain, kidneys, and other vital organs.
What is the first change in seen in vital signs in hypovolemic shock?
1. hypotension
2. tachypnea
3. narrowed pulse pressure
4. hypertension
5. tachycardia
6. bradycardia
Increase in diastolic blood pressure with narrowed pulse pressure.
Which is a result the release of histamine can have on the body?
1. diuresis
2. increased glucose
3. pulmonary edema
4. hypertension
-drop in blood pressure
-Fluid can leak into the lungs, causing swelling (pulmonary edema)
-heart rhythm disturbances.
Name three complications of septic shock.
1. acute liver failure
2. GI bleed
3. ARDS
4. breast cancer
5. multiple organ dysfunction syndrome
ARDS
Acute/chronic renal injury
DIC
Mesenteric ischemia
Acute liver failure
Myocardial dysfunction
Multiple organ failure
Define neurogenic shock.
1. Injury to the spinal cord with associated autonomic dysregulation
2. Injury to the brain stem with associated autonomic dysregulation
3. Injury to chest wall with associated autonomic dysregulation
Injury to the spinal cord with associated autonomic dysregulation.
What are the symptoms of cardiogenic shock? SATA
1. orthostatic changes
2. confusion
3. tachypnea
4. loss of consciousness
5. vomiting blood
6. increased bruising
A patient may have mild symptoms, such as feeling confused or breathing rapidly, or may have no symptoms and then suddenly lose consciousness.
What are four signs of hypovolemic shock?
-increased heart rate
-increased cardiac contractility
-increased peripheral vasoconstriction
-decreased systolic blood pressure
-dry mucous membranes
-decreased skin turgor
-low jugular venous distention
-decreased urinary output.
-appear cold, clammy, and cyanotic
1. moist mucous membranes
2. adequate urine output
3. increased heart rate
4. hypertension
5. decreased systolic hypertension
6. dry mucous membranes
7. skin warm, dry and pink
8. decreased skin turgor
What are three of the most common food allergies?
1. gluten
2. peanuts
3. eggs
4. chocolate
5. strawberries
6. cow's milk
-peanuts
-walnuts and hazelnuts
-fish
-chicken eggs
-cow's milk
Name two interventions used to treat septic shock.
1. encourage oral intake
2. IV fluids
3. mechanical ventilation
4. echocardiogram
5. surgical intervention
1. Fluid resuscitation with crystalloid (NS or albumin) and colloid (blood products) up to 80 ml/kg
2. Mechanical ventilation to reduce metabolic demand
3. First-line vasoactive agents (epinephrine in cold shock versus norepinephrine in warm shock) when fluid-refractory
Name three signs/symptoms seen in neurogenic shock?
1. hypertension
2. cool pale skin
3. hypotension
4. bradyarrythmia
5. temperature dysregulation
6. increased urination
-Bradyarrhythmia
-hypotension
-flushed warm skin
(These first three are the most common)
-orthostatic hypotension
-autonomic dysreflexia
-temperature dysregulation
Name four cardiac conditions that put you at risk for cardiogenic shock?
Choose four symptoms patients may complain of that are signs of hypovolemic shock.
Thirst, muscle cramps, orthostatic hypotension, abdominal or chest pain (due to mesenteric and coronary ischemia), agitation, lethargy, or confusion (as a result of brain malperfusion).
1. thirst
2. anxiety
3. lethargy
4. shortness of breath
5. chest pain
6. agitation
7. urinary frequency
8. nausea
Name two treatments for neurogenic shock.
1. anti-hypertensives
2. lipid-lowering agents
3. atropine
4. fluid restriction
5. iv fluids
- iv fluids
-vasopressors
-atropine
-spinal immobilization
-surgical intervention
Which types of medications might be used to treat cardiogenic shock? SATA
1. beta-blockers
2. vasopressors
3. lipid lowering agents
4. blood thinners
5. diuretic
Anti-arrhythmic, blood thinner or anti-platelet, vasopressors or inotropes
Which of the following occur in the body during hypovolemic shock? SATA
1. hypovolemia
2. fluid overload
3. decreased peripheral perfusion
4. infection
Severe hypovolemia with decreased peripheral perfusion.
What are three symptoms of Anaphylactic shock?
Besides medications, name three treatments for cardiogenic shock.
Pacemaker/defibrillator, balloon pump, CABG, ECMO, ventricular assist device, heart transplant and hospice if recovery if survival not expected.
1. CPR
2. CABG
3. cardioversion
4. pacemaker/defibrillator
5. hospice
How long can neurogenic shock signs/symptoms continue for?
1. 3-5 days
2. 1 week
3. 4-5 weeks
4. 24 hours
4-5 weeks